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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
Which antibiotic should I prescribe (if indicated)? (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)

  • Oral flucloxacillin is recommended for empirical treatment of Staphylococcus aureus infections.
  • Oral erythromycin (or clarithromycin if erythromycin is not tolerated) are alternatives for people with penicillin allergy.
  • If there is no response to treatment, or if the infection is recurrent or chronic, the choice of antibiotic should ideally be guided by sensitivities.
Basis for recommendation
  • Flucloxacillin has a narrow spectrum of activity, and is active against most susceptible Gram-positive cocci, including beta-lactamase–producing staphylococci and streptococci. However, it is not active against MRSA (methicillin-resistant Staphylococcus aureus), which is increasingly prevalent in the UK. It diffuses well into most tissues, so is suitable for skin and soft tissue infections [Finch et al, 2003].
  • Erythromycin and clarithromycin have a broad spectrum of activity and are active against most sensitive Gram-positive cocci (including staphylococci and streptococci) and some Gram-negative cocci and anaerobes [Finch et al, 2003].
  • Clarithromycin may be used in people who are known not to tolerate erythromycin. It is more effective against common pathogens than erythromycin, and has fewer gastrointestinal adverse effects [Finch et al, 2003]. However, it is markedly more expensive than erythromycin.
  • Azithromycin (and other macrolides) are not recommended for empirical treatment as there are concerns about increasing resistance [McNulty, Personal Communication, 2006].

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